关键词: 肝硬化, 急性肾损伤, 血管紧张素原, 中性粒细胞明胶酶相关脂质运载蛋白, 肾损伤因子-1

Abstract: Objective To investigate the predictive value of dynamic changes of new biomarkers in hypervolemic therapy for liver cirrhosis with acute kidney injury (AKI). Methods Patients with liver cirrhosis complicated with AKI in our hospital from May 2017 to April 2018 were consecutively enrolled. The patients' general clinical data and laboratory examination results were collected. Urine samples were collected the day diagnosing AKI and 2 days after hypervolemic therapy. Urine angiotensinogen (uAGT), urine neutrophil gelatinase-associated lipocalin (uNGAL), urine kidney injury molecule-1 (uKIM-1) and urine creatinine (uCr) were measured. The patients were divided into effective group and ineffective group. Indexes above, the defferences and decrease rate of urine indexes before and after volume expansion were compared between 2 groups. Results There was no significant difference in alanine aminotransferase, aspartate aminotransferase, platelet count, hemoglobin, white blood cell count, total bilirubin, direct bilirubin, blood urea nitrogen, albumin between the effective group and the ineffective group (P>0.05). Prothrombin time activity (PTA) in the effective group was significantly higher than that in the ineffective group (P=0.020), and the blood creatinine was lower in the effective group than that in the ineffective group (P=0.047). The proportion of patients with upper gastrointestinal bleeding in effective group was higher than that in ineffective group (63.6% vs. 25.0%, P=0.011). In the diagnosis of AKI, uAGT/uCr and uKIM-1/uCr were not statistically different between 2 groups; the uNGAL/uCr of the ineffective group was statistically higher than that of the effective group (45.8 vs.188.8 ug/g, P=0.011). The indicators above before and after the expansion were compared between 2 groups. In effective group, the decrease values of uAGT/uCr (0.02 vs.-0.99 ug/g, P=0.056), uNGAL/uCr (20.73 vs.-37.36 ug/g, P=0.052), uKIM-1/uCr (2.06 vs.-0.12 ug/g, P=0.082) were higher than those in the ineffective group, but the difference was not statistically significant. The decrease rates of uNGAL/uCr and uKIM-1/uCr in the effective group were significantly higher than those in the ineffective group (51.0% vs. 19.6%, P=0.001; 65.3% vs. 37.5%, P=0.004). Multivariate regression analysis showed that upper gastrointestinal bleeding was an independent predictor of the effectiveness of volume expansion therapy for AKI patients with cirrhosis. Conclusion The dynamic changes of uNGAL and uKIM-1 levels, upper gastrointestinal bleeding, serum creatinine and PTA could predict the expansion effect of AKI patients with cirrhosis.

Key words: Cirrhosis, Acute kidney injury, Angiotensinogen, Neutrophil gelatinase-associated lipocalin, Kidney injury molecule-1